Ability of non‐invasive intermittent blood pressure monitoring and a continuous non‐invasive arterial pressure monitor (CNAP<sup>™</sup>) to provide new readings in each 1‐min interval during elective caesarean section under spinal anaesthesia

McCarthy, Tommie V.; Telec, N.; Dennis, A.T.; Griffiths, J. D.; Buettner, A.

doi:10.1111/j.1365-2044.2011.06996.x

Cited by 28 publications

(15 citation statements)

References 11 publications

(13 reference statements)

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“…Their study results showed that the standard deviation of the difference between the two devices was approximately ± 12 mmHg at the mode (75 mmHg MAP). 95 While these authors did not calculate the limits of agreement, a rough estimate that does not take into account repeated measures suggests that the confidence intervals of standard NIBP are worse than those reported in a number of volume-clamp studies [e.g., Martina (Nexfin), 96 Weiss (Nexfin), 97 Jeleazcov (CNAP), 98 Jagadeesh (CNAP), 99 Dewhirst (CNAP), 100 Tobias (CNAP), 101 and Ilies (CNAP)] 102 but similar to those in other volume-clamp studies [Biais (CNAP), 103 Hahn (CNAP), 104 McCarthy 2012 (CNAP), 105 and Schramm (CNAP)]. 106 At the extremes (significantly above or below a MAP of 75 mmHg), when accurate measurement of blood pressure is increasingly important, NIBP performance deteriorated.…”

Section: Clinical Contextmentioning

confidence: 51%

Advances in photoplethysmography: beyond arterial oxygen saturation

Bartels

Thiele

2015

Can J Anesth/J Can Anesth

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Purpose Photoplethysmography permits continuous measurement of heart rate and peripheral oxygen saturation and has been widely used to inform clinical decisions. Recently, a myriad of noninvasive hemodynamic monitoring devices using this same technology have been increasingly available. This narrative review aims to summarize the principles that form the basis for the function of these devices as well as to comment on trials evaluating their accuracy and clinical application. Principal findings Advanced monitoring devices extend photoplethysmography technology beyond measuring oxygen concentration and heart rate. Quantification of respiratory variation of the photoplethysmographic waveform reflects respiratory variation of the arterial pressure waveform and can be used to gauge volume responsiveness. Both the volume-clamp and physiocal techniques are extensions of conventional photoplethysmography and permit continuous measurement of finger arterial blood pressure. Finger arterial pressure waveforms can subsequently inform estimations of cardiac output. Conclusions Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes. RésuméObjectif La photopléthysmographie permet la mesure continue de la fréquence cardiaque et de la saturation en oxygène périphérique, et elle est largement utilisée pour les prises de décisions cliniques. Depuis peu, un très grand nombre de dispositifs non invasifs de surveillance hémodynamique utilisant la même technologie envahit le marché. Cette synthèse narrative vise à résumer les principes à la base du fonctionnement de ces dispositifs et à commenter les essais évaluant leur exactitude ainsi que leurs applications cliniques. Constatations principales Les dispositifs de surveillance avancée étendent la technologie de photopléthysmographie au-delà de la mesure de la concentration en oxygène et de la fréquence cardiaque. La quantification de la variation respiratoire du tracé photopléthysmographique reflète la variation respiratoire du tracé de pression artérielle et peut servir à jauger la réactivité au volume. Les deux techniques de compression volumique (volume-clamp) au doigt et la technique physiocal sont des prolongements de Author contributions Karsten Bartels wrote approximately 50% of the manuscript and critically edited the remainder. Robert H. Thiele wrote approximately 50% of the manuscript and critically edited the remainder.

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Section: Clinical Contextmentioning

confidence: 51%

Advances in photoplethysmography: beyond arterial oxygen saturation

Bartels

Thiele

2015

Can J Anesth/J Can Anesth

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“…This is a very large potential source of bias. Indeed, McCarthy et al, 1 in a study comparing CNAP and traditional NIBP in cesarean delivery patients undergoing spinal anesthesia, noted that the CNAP device failed at a higher rate than NIBP measured every minute.…”

Section: Commentmentioning

confidence: 97%

Detection of Hypotension During Cesarean Section With Continuous Noninvasive Arterial Pressure Device or Intermittent Oscillometric Arterial Pressure Measurement

Ilies

Kiskalt

Siedenhans

et al. 2013

Obstetric Anesthesia Digest

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BMI < 25 kg/m 2 compared to 6.6% in women with BMI > 40 kg/m 2 . One option to reduce this rate is to tape the catheter after the patient is in the lateral position or in the position in which she is most likely to labor. Catheter position and anesthetic levels should be checked at least every 2 hours during labor to ensure correct position and adequate function.Labor analgesia in obese parturients requires a prelabor consultation to create an anesthetic plan, a check of equipment for appropriate size and function, presence of experienced staff and anesthesia providers, early initiation of neuraxial anesthesia, an appropriate method to locate landmarks, minimization of catheter movement, anticipation of difficulties with prolonged labor and likelihood of CD, evaluation of the neuraxial block every 2 hours, and frequent communication with the patient and all involved with care.T he increase in the use of spinal anesthesia for cesarean delivery has led to decreased maternal death and morbidity. However, hypotension during spinal anesthesia is a common side effect, with an incidence as high as 95%. Because of the potential harm of maternal hypotension to the fetus and the dependency of fetal oxygenation on maternal blood pressure (BP), the mother's BP should be monitored closely and hypotension treated immediately. Traditionally, BP is monitored with discontinuous oscillometric measurements [noninvasive blood pressure (NIBP)], but because it is not continuous, hypotensive episodes may be missed. A continuous NIBP device (CNAP Monitor 500) has shown agreement with invasive BP measurements. The CNAP system consists of a double finger cuff, a pressure monitor mounted on the forearm, and an oscillometric cuff mounted on the upper arm. The CNAP device is designed to keep the volume of blood in the finger arteries constant by altering pressure applied to the finger. The pressure applied during arterial pulsation is related to the arterial BP. This study was designed to investigate whether the CNAP device is more reliable in detecting episodes of hypotension than conventional NIBP measurement during cesarean delivery under spinal anesthesia.Patients received an intravenous preload with 500 mL starch solution, and spinal anesthesia was induced with hyperbaric bupivacaine of 10 to 12.5 mg. Eighty patients undergoing planned cesarean delivery were monitored with the CNAP device, and traditional NIBP was measured at 3-minute intervals until delivery. The CNAP finger cuff and the NIBP cuff were on the same arm. The CNAP monitor was calibrated before the first measurements and every 30 minutes thereafter during the comparison trial. Baseline NIBP was the first measurement obtained in the operating room. Baseline CNAP was averaged from the first 100 beats after the device was calibrated. Hypotension was defined as a decrease in systolic BP by >20% or systolic BP < 100 mm Hg. Hypotension was treated with a standardized protocol with Akrinor and hydroxyethyl starch, if necessary. The mean BP for the highest and lowest CNAP per 3-mi...

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“…The PulseCO algorithm that was used in analysis of arterial pressure curve by LiDCORapid monitor, has been validated and used in healthy, pregnant patients receiving spinal anaesthesia (66,67). The absolute value of CI measured with this method has been controversial, however its value for monitoring the trends in CI values has been validated and accepted, also in spinal anaesthesia (30,63,68). We were aware of the limitations of the method used in the assessment of absolute values of CI; also in SVRI calculations the mean atrial pressure was not measured but arbitrarily set to 7 mmHg.…”

Section: Discussionmentioning

confidence: 99%

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

2017

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Background: For some surgical procedures a higher sensory block is needed. However, it is complicated by a higher incidence of hypotension, more bradycardia and nausea and a higher use of vasoactive drugs. In elderly and obstetric population complications have been attributed to the decrease in cardiac output and systemic vascular resistance, especially in a high block (above Th6). The aim of our study was to find the incidence of hypotension and bradycardia after a spinal anaesthesia in young, healthy patients. As young patients compensate more, we aimed to find the difference in haemodynamic variables between the group with a high and the group with a low spinal block and the underlying mechanisms of hypotension. Methods: in a prospective, randomized study 44 ASA 1 patients scheduled for knee arthroscopy under spinal anaesthesia were randomly distributed to a high (group H) and a low (group L) spinal block group. In a group H patients were placed into horizontal, whereas in a group L in 15-degree anti-Trendelenburg position immediately after the spinal block. Haemodynamic parameters were measured continuously noninvasively from 10 min before to 25 min after the spinal block using the CNAPTM device with the LiDCORapid monitor. Results: The differences in haemodynamic parameters between the groups were not statistically significant at all measured times despite a significant difference in the spinal block level (18.5 vs 13.3 dermatomes above S5, p<0.001) and a significant

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Ability of non‐invasive intermittent blood pressure monitoring and a continuous non‐invasive arterial pressure monitor (CNAP^™) to provide new readings in each 1‐min interval during elective caesarean section under spinal anaesthesia

Cited by 28 publications

References 11 publications

Advances in photoplethysmography: beyond arterial oxygen saturation

Advances in photoplethysmography: beyond arterial oxygen saturation

Detection of Hypotension During Cesarean Section With Continuous Noninvasive Arterial Pressure Device or Intermittent Oscillometric Arterial Pressure Measurement

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

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Ability of non‐invasive intermittent blood pressure monitoring and a continuous non‐invasive arterial pressure monitor (CNAP™) to provide new readings in each 1‐min interval during elective caesarean section under spinal anaesthesia

Cited by 28 publications

References 11 publications

Advances in photoplethysmography: beyond arterial oxygen saturation

Advances in photoplethysmography: beyond arterial oxygen saturation

Detection of Hypotension During Cesarean Section With Continuous Noninvasive Arterial Pressure Device or Intermittent Oscillometric Arterial Pressure Measurement

Comparison of haemodynamic parameters between the high and low spinal block in young healthy patients

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Ability of non‐invasive intermittent blood pressure monitoring and a continuous non‐invasive arterial pressure monitor (CNAP^™) to provide new readings in each 1‐min interval during elective caesarean section under spinal anaesthesia